ASSH Policies

The American Society for Surgery of the Hand (“ASSH”) is committed to complying with ACCME’s Standards for Commercial Support for all of its continuing medical education (CME) eligible activities. ASSH’s CME Conflict of Interest Policy and Disclosure Form is intended to comply with ACCME’s requirements and is in addition to ASSH’s General Conflict of Interest Policy and Disclosure Form, which is also applicable. The responsibility for managing ASSH’s CME Conflict of Interest Policy is under the control of the CME Advisory Group (CME-AG) which (i) reports to Council (the ASSH’s governing board); (ii) establishes ASSH’s rules, responsibilities and processes with respect to compliance with ACCME’s requirements for identification, disclosure and resolution of COI; and (iii) has the authority to implement, apply, and interpret ASSH’s CME Conflict of Interest Policy and ASSH’s General Conflict of Interest Policy as it may apply to CME related activities. The CME-AG is chaired by ASSH’s Education Division Director.

Disclosure Requirements
Every person who has the potential to affect the content of a CME activity must complete a Disclosure of Relevant Financial Relationships for Continuing Professional Education form (CME Financial Disclosure Form) and submit it to ASSH prior to their invitation to participate in a CME related activity, where practical, and in all cases, as follows:

For Planners, the CME Financial Disclosure Form must be returned prior to planning the activity.

For faculty/moderators/presenters/authors, the CME Financial Disclosure Form must be returned prior to developing their course materials.

For Reviewers, the CME Financial Disclosure Form must be returned prior to the commencement of content review.

Persons who perform CME related duties on a regular and ongoing basis must complete Disclosure Forms annually. All other persons must complete forms in the course of their becoming involved in CME related activity. Everyone must provide updates if a change in relevant financial relationships has occurred.

Independence
All persons who have the potential to affect the content of a CME activity must ensure that:

All recommendations involving clinical medicine in a CME activity are based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients.

All scientific research referred to, reported or used in a CME activity or in support of a patient care recommendation conform to generally accepted standards or experimental design, data collection and analysis.

Content is linked to the learning objectives for the activity, pertinent to the target audience and free of commercial bias.

Resolution of Personal Conflicts of Interest
It is ASSH’s intent that all relevant financial relationships with commercial interests are identified in a timely manner and any resulting conflicts of interest (“COI”) are resolved appropriately. A “commercial interest” is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

A “relevant financial relationship” is any amount occurring within the past 12 months that creates a conflict of interest. Please note that ASSH’s General Conflict of Interest Policy defines financial relationships more broadly. ASSH will review and assess disclosed commercial interests and the identification of relevant financial relationships at the earliest possible occasion with the goal of determining and resolving any potential or relevant COI (as defined by either ASSH’s General or CME Conflict of Interest Policies) prior to the commencement of any affected CME related activity.

Implementation Procedures
All CME Disclosure Forms will be reviewed by ASSH’s Vice President of Professional Development to ensure (i) compliance with ASSH’s CME Conflict of Interest Policy; (ii) resolution of COI consistent with ACCME’s requirement occurs as necessary; (iii) any potential COI matters under ASSH’s General Conflict of Interest Policy are identified and addressed; and (iv) any questions or issues requiring follow-up are referred to the CME-AG. ASSH may from time to time adopt additional procedures for implementing this policy and for handling CME related COI matters.

If the Vice President of Professional Development has any initial questions or concerns regarding a CME Financial Disclosure Form, she will send the CME Financial Disclosure Form(s) in question to the applicable course chair(s) for their review and for them to provide guidance on whether a relevant financial relationship with a commercial interest creates a COI that must be resolved.

In general, if the Vice President of Professional Development identifies a relevant financial relationship, the following occurs:

Unresolvable Conflicts

No one will be allowed to plan, present, or affect the content of an ASSH CME activity related to that person’s relevant financial relationship with a commercial interest. Anyone with such a COI must recuse themselves from participating in the affected activity. In the alternative, ASSH will not invite them to participate, will preclude them from participating, or, as necessary, will remove them from participation. In special circumstances, persons with unresolvable conflicts may be considered a critical source of expertise for CME planning purposes. In such cases, ASSH’s CME-AG will appoint one of its members to review and oversee the planning process to ensure that the CME activity is fair, balanced, and without commercial bias.

Resolvable Conflicts

Where COI can reasonably and appropriately be resolved, ASSH will work with the affected parties to take steps to resolve their conflicts. For example:

Planners/reviewers will not be allowed to plan/review the content relevant to their reported COI or another planner/reviewer will be required to participate to ensure fair balance.

Planners/reviewers should not have any relevant COI. Where relevant COI is present, another reviewer should be selected with no relevant COI. In the rare circumstance where every potential reviewer has one or more conflicts and there is no qualified reviewer without relevant COI, then two reviewers should be utilized as a check-and-balance and/or a member of the CME-AG shall perform the review.

Faculty/presenters will have their CME content independently reviewed to ensure that the faculty presenter: (i) does not make recommendations or topics related to their COI; (ii) makes any recommendations for patient care on peer reviewed data; or (iii) re-submits and limits the scope of their presentation as needed to resolve the COI as determined by ASSH’s Professional Development Office.

Faculty/presenters who have a relevant COI with any grantors of the CME activity, or with content to be discussed during their presentation that is related to their COI, will have their content reviewed prior to presentation by the assigned non-conflicted reviewer for the activity and/or a member of the CME-AG. Any content determined by the reviewer to have commercial bias, lack of fair balance or other concerns, may not be presented until it is limited/corrected and re-reviewed by the CME-AG or the course chair.

To avoid having the process for managing resolvable conflicts interfere with the timely development and implementation of CME activities, all persons with a resolvable conflict must present their relevant presentation/materials to ASSH for review no later than three weeks prior to the CME activity. Whenever corrections or changes are required, the affected person must make those changes/corrections within three business days and re-submit their presentation/materials to the assigned reviewer for final approval. A person with a resolvable conflict can only participate in the affected CME activity after review and final approval by the ASSH under this policy.

Documentation, Interpretation and Final Adjudication
All actions and decision implementing this policy must be documented and made a part of the CME activity file.

Any questions concerning whether a COI exists, whether it is unresolvable, or whether it is properly resolved and/or otherwise managed will be determined in the sole discretion of the CME-AG. In addition, the CME-AG has the authority to determine how to manage any potential conflicts that are disclosed, or that should have been disclosed, under ASSH’s General Conflict of Interest Policy and Disclosure Form.

Transparency
ASSH will provide all learners (i.e., CME Participants) with information about the relevant financial relationships of all persons that affect the content of CME related activities pursuant to this policy and with other information that ASSH determines should be disclosed pursuant to ASSH’s General Conflict of Interest Policy. All such information will be positioned in course materials and/or opening slides such that it is easily seen by learners prior to the commencement of the CME activity (e.g., at the beginning of course handouts or the beginning of each presentation).

Questions

Any questions about this policy should be directed to the attention of ASSH’s Vice President of Professional Development at [email protected]

To ensure ethical decision making and avoid conflicts of interest, or the appearance thereof, the American Society for Surgery of the Hand (ASSH) has adopted the following Policy on corporate support:

ASSH will accept corporate support only for activities that are consistent with ASSH’s purposes.

ASSH will not accept corporate support in a form or manner that could be interpreted as ASSH’s endorsement of a corporate supporter, its products, or services, and will take steps to avoid such appearances.

ASSH shall at all times make decisions with respect to its policies, programs and publications independent of corporate support and shall avoid actions which would give the appearance that corporate support had any influence on, or was a factor in making, such decisions.

ASSH will conduct its educational programs in a manner consistent with the Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support of Continuing Medical Education and in compliance with all applicable federal, state, and local rules and regulations.

ASSH will have responsibility for the criteria, objectives, content, quality, and scientific integrity of such programs and publications.

ASSH will avoid the appearance that corporate supporters have authority to make decisions regarding program or publication content, program development, speaker/author selection, or the like.

All decisions with respect to programs and publications will be made by ASSH staff, members, or agents who have no conflict of interest with the funding source.

ASSH will not accept funds for, nor will it sponsor or co-sponsor, any programs or publications that are tied to the products or services of a corporate supporter unless such program or publication clearly disclose such corporate support.

ASSH may acknowledge corporate support, provided any such acknowledgement only is made in a manner that minimizes the likelihood that the income from corporate support will be considered taxable by the Internal Revenue Service as unrelated business income.

ASSH may allow its name, logo, and/or membership mailing list (collectively, the “ASSH Marks”) to be used in connection with corporate support only if:

The ASSH Marks are used for the purpose of promoting or advancing ASSH’s purpose and mission, as determined by ASSH in its sole discretion.

The use of the ASSH Marks is provided on a non-exclusive basis.

The use of the ASSH Marks does not constitute an endorsement of any particular product, service or corporation.

The ASSH Marks do not appear alongside the name, trademark, service mark, or logo of any association or corporation other than that of the corporate supporter without ASSH’s prior written approval.

All proposed uses of the ASSH Marks are subject to the prior review and written approval of ASSH.

The provision of goods and/or services under the ASSH Marks do not reflect adversely upon the ASSH or the ASSH Marks.

ASSH shall retain the right to terminate any use of the ASSH Marks at any time and for any reason, upon reasonable prior written notice.

ASSH shall, if possible, seek a royalty or other form of revenue stream as consideration for the use of the ASSH Marks. Such revenue stream shall, when possible, be constructed to avoid the generation of unrelated business income tax.

The receipt and use of corporate support, including, without limitation, a corporate supporter’s use of the ASSH Marks, will be subject to a written agreement in a form acceptable to ASSH in its sole discretion.

For purposes of this policy, “corporate support” does not include paid advertising by corporate supporters for ASSH programs or publications or payment for goods or services provided to the corporate supporter by ASSH (e.g., exhibitor fees; annual meeting registration fees).

ASSH members will be allowed to import the content of the ASSH patient education brochures to their personal website(s), at no cost. The website makes clear that by using the brochure, members will acknowledge that the material is copyrighted by the ASSH, and that if they modify the information, they must indicate that the information is “modified from ASSH.”

Non-members and for-profit entities must contact ASSH for permission to use specific online brochures. These users will not be allowed to modify the brochures in any way. The Website Committee approved a fee of $1,000 per brochure for commercial users.

Definition of Enduring Materials

The ACCME defines CME enduring materials as non-live CME activities that endure over time. Enduring materials exist in various formats, such as the Internet, podcasts, satellite broadcasts, videotapes, monographs, DVD, CD Rom or other formats that allow the learning experience to take place at any time in any place.

Policy

CME Information Provided to Learners

For enduring CME activities in which the learner participates electronically (e.g., via Internet, CD-ROM, satellite broadcasts), it is the policy of American Society for Surgery of the Hand (ASSH) that the following CME information be transmitted to the learner prior to beginning the CME activity in such a manner that the information must be read, without an opt-out option, before proceeding to the content of the activity:

Direct or joint sponsorship statement

Name and credentials of faculty

Release and expiration dates, review dates (if activity is extended)

Time to complete the activity, including the evaluation and/or post-test (same as AMA PRA Credit designation statement)

Disclosure statements of anyone with a financial relationship with the supporter(s) or manufacturers of products related to the content (if none, state no relationships), but must include the roles of everyone involved in the development/planning or execution the activity

Acknowledgment of commercial support

Medium or media used

Method of participation (instructions describing how learners will participate in the activity and receive CME credit)

Evaluation and Post Test

ASSH requires each enduring material to include an evaluation that measures outcomes related to the designation of the activity (competence, performance, patient outcomes), an assessment of the learners achievement of the activity goal or learning objectives based on minimum thresholds established by ASSH. Learners must demonstrate a determined level of mastery of the material presented. The minimum level of performance criteria is 100% correct for Journal CME and Internet CME. For self-assessment examination, the minimum level of performance criteria is 50% correct.

Evaluation and post tests are considered part of the CME content and must ads may not appear between the CME content and these aspects of the CME activity.

Securing CME Credit

ASSH determines CME credit for each activity based on a good faith estimate of the amount of time it will take learners to complete the activity, as determined by a small sampling of the target audience to determine the average length of time to complete the activity.

Credits are awarded to learners (1) who meet the minimum performance level as stated above and (2) as claimed by the learner up to the maximum credits for which the activity was certified.

Enduring activities are approved for up to three years or less depending on the half-life of the information in the activity as determined in the original planning process or as indicated by new scientific developments. Prior to renewing an activity, ASSH will convene a panel of experts to ensure that content is accurate and up-to-date.

Maintenance of Copies of the Enduring Material during the Accreditation Cycle

ASSH maintains a paper or electronic version of each enduring material, even after it has expired, during the current accreditation cycle so that it may be viewed upon request by the ACCME.

Placement of CME Activities on a Site Owned or Controlled by a Commercial Interest

If an activity is web-based, it is the policy of the ACCME and ASSH that such enduring materials be placed either on its own website, or if another site provides distribution of the activity as a vendor, then that site may not be owned or related to a commercial interest.

Advertisements in Enduring Materials

ASSH does not permit advertisements in enduring materials

Referencing Trade Names

As a general rule, ASSH does not reference trade-named products in its enduring materials. Should a situation arise in which the use of a trade name is warranted because learners would not recognize the generic or scientific name of the product referenced in the context of treatment discussions, then all products mentioned should reference their trade names so as not to distinguish the products of a company supporting the activity.

Maintaining Independence in the Planning and Execution of an Enduring Material

ASSH requires that the planning and execution of enduring materials ensure the following:

The content of CME activities does not promote the proprietary interests of commercial interests.

CME activities gave a balanced view of therapeutic options and conform to the generally accepted standards of experimental design, data collection and analysis.

Recommendations involving clinical medicine in a CME activity are based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients.

Content does not contain recommendations, treatment or manners of practicing medicine that are not within the definition of CME, or are known to have risks or dangers that outweigh the benefits, or are known to be ineffective in the treatment of patients.

Distribution of Course Content by a Commercial Interest

ASSH does not permit representatives of commercial supporters to assist in the distribution of enduring materials. However, at the request of ASSH, a commercial supporter may assist in the distribution of materials that promote the availability of the enduring material so long as it is produced by ASSH and that material clearly identifies ASSH as the CME provider and the supporter for the provision of an educational grant.

The American Society for Surgery of the Hand (“ASSH”) is dedicated to advancing the study and practice of surgery of the hand. To accomplish that mission, it provides support, directly or indirectly, for a variety of activities in the areas of research, education, promotion, and advocacy. The integrity of ASSH, and the activities it undertakes, depends on the avoidance of conflicts of interest, or even the appearance of such conflicts, by the individuals involved in those activities.

At the same time, ASSH recognizes that the elected and appointed leaders of ASSH, as well as other individuals acting on its behalf, also have significant professional, business and personal interests and relationships. Therefore, ASSH has determined that the most appropriate manner in which to address actual, potential or apparent conflicts of interest is initially through liberal disclosure of any relationship or interest which might be construed as resulting in such a conflict. Disclosure under this Policy should not be construed as creating a presumption of impropriety or as automatically precluding someone from participating in an ASSH activity or decision-making process. Rather, it reflects ASSH’s recognition of the many factors that can influence one’s judgment and a desire to make as much information as possible available to other participants in ASSH-related matters.

ASSH acknowledges that some conflicts cannot be “managed.” There are some unresolvable conflicts. As such, under certain circumstances mere disclosure is not sufficient; a person with a disclosed conflict must be precluded from participating in a particular activity. For example, the ACCME’s Standards for Commercial Support, which ASSH supports and follows, sets forth certain situations where persons who have the potential to affect the content of a CME entity may not be allowed to participate in CME related activities because their conflicts are unresolvable. ACCME’s separate conflict of interest disclosure requirements and policies are incorporated as part of ASSH’s more general conflict of interest policy.

General Disclosure Requirements

Any individual involved in an ASSH activity or decision-making process shall disclose any conflicting or potentially conflicting personal, professional or business interest he or she may have, directly or indirectly, with the affected activity or decision. Potentially conflicting interests may relate to ASSH’s programs and services (e.g., educational courses, research grants, journal matters) or its operations (e.g., contracts with third parties). “Directly or indirectly” relates not only to the individual’s potential conflicts but also those of others (e.g. family members, business partners, etc.) that could affect the individual’s decision-making.

In particular, participants in ASSH-related activities are obligated to disclose the positions they hold or relationships they have within ASSH and with other organizations or entities that may conflict, directly or indirectly, with their ASSH activities. They also have an obligation to disclose any significant financial interest in, or other relationship with, an entity having a “commercial interest” in the activity. A commercial interest may exist not only where the entity’s products or services are under consideration by ASSH, but also where the entity’s products or services are in competition or potential competition with those under consideration. By the disclosure of such interests, Council or its designee(s) will be in a better position to determine whether the participant may have an interest in conflict with the interests of ASSH.

ASSH primarily is concerned with potential conflicts of interest involving those individuals participating directly in ASSH-related activities. Potential conflicts of interest also may arise, however, if an individual with whom the participant directly shares income (e.g., a spouse, minor child, or business partner) or a third party whose interest may affect the participant’s decision-making (e.g., a sibling or adult child) has an interest in, or relationship with, an entity having a commercial interest in the activity or matter under consideration. As a result, participants should disclose not only their own interests or relationships but also those of their spouse, minor children, or business partners. In addition, participants should disclose interests or relationships held by others that may affect their decision-making, but only to the extent they are aware of such information. Participants are under no obligation to determine the nature of every interest held by a sibling, business partner, etc. if they have no independent knowledge of such interests.

Comparable principles apply to participants’ obligations to disclose research grants received by the institution(s) with which they are affiliated. In addition to grants received for their own research, participants are presumed to know what grants have been received by other members of their department engaged in upper extremity-related research. Therefore, those grants also should be disclosed. In contrast, participants have no affirmative obligation to ascertain the nature of grants received by others in their institution. If they are aware of such grants, however, those also should be disclosed.

In general, participants should err on the side of disclosure if in doubt as to whether it is required under the Policy. Examples of relationships or interests related to ASSH or hand surgery which should be disclosed include:

Positions in ASSH - All positions currently held or sought in ASSH (e.g., Council or committee member, editor, course or publication contributor), as well as any other current or proposed relationship with ASSH (e.g., service provider, paid consultant) must be disclosed.

Relationships with Other Organizations/Entities - Any leadership role in, or other relationship with, another organization or entity (e.g., board member, committee member, advisor, journal contributor) directly or indirectly related to ASSH or hand surgery must be disclosed.

Employment - Any current or proposed full- or part-time employment, as well as any employment within the previous three (3) years, must be disclosed.

Consultancies - Any current or proposed consulting arrangements, as well as any consulting performed or paid for within the previous three (3) years, must be disclosed.

Royalties - Any individual or entity that is currently paid or has paid (in the past three (3) years) or is about to pay, royalties or similar payment, must be disclosed.

Ownership Interests - Any ownership interests (including stock options but excluding indirect investments through mutual funds and the like) in a company, the stock of which is not publicly traded, must be disclosed. Ownership interests in excess of $10,000.00 in companies that are publicly traded also must be disclosed. In addition, any other ownership interests in an entity having a commercial interest in an activity or matter under consideration by ASSH must be disclosed.

Honoraria - Honoraria or other reasonable payments for seminar presentations, speeches, or appearances must be disclosed in the event the amount paid within the previous three (3) years, or about to be paid, is equal to or greater than $2,500.00 per year or $5,000.00 over a three-year period.

Research Funding - Receipt of funds for conducting research must be disclosed.

General Disclosure Form

Integral to the implementation of the Conflict of Interest Policy is the ASSH Conflict of Interest Disclosure Form, a copy of which is attached as Attachment A, which shall be considered a part of the Conflict of Interest Policy and must be submitted by any individual participating in an ASSH activity. Initially, a participant’s obligation to report actual, potential or apparent conflicts is discharged by completing the Disclosure Form. Participants remain under a continuing obligation, however, to report such conflicts as they arise, including those that were not reported on the Disclosure Form, but which later become relevant to the ASSH activity in which they are involved.

For example, an individual appointed to serve as editor of an ASSH publication is not expected to anticipate all the conflict situations that may arise during the course of that appointment. If, however, the editor is asked to review an article submitted for publication that could affect, directly or indirectly, an entity in which the editor has a financial or other interest, the editor has an obligation to disclose the potential conflict to Council, or its designee(s), before becoming involved in a review of the article.

Disclosure Forms shall be kept on file at the ASSH Central Office for a period of two (2) years, or one (1) year after the conclusion of the relevant activity or decision-making process, whichever is longer, unless otherwise determined by Council.

General Implementation Procedures

All participants in ASSH-related activities, including CME-related activity, must comply with the ASSH Conflict of Interest Policy. It is the responsibility of the disinterested members of Council or designated committee chairs, editors, etc. to apply and abide by this Policy. Inasmuch as the Policy is stated in general terms, they should use their best judgment in doing so.

In order to facilitate implementation of the Conflict of Interest Policy, Council or its designee(s) shall determine, based on the disclosure form and other relevant information, when an individual engaged in, or about to engage in, an ASSH-related activity or other matter under consideration has an actual, potential, or apparent conflict of interest requiring some response by ASSH. Specifically, subject to the procedures set forth herein, Council or its designee(s) may require any action they deem appropriate, including, but not limited to, the following:

Disclosure of the interest to the other participants in the decision- or policy- making body (e.g., committee, editorial board).

Written and, in some cases, oral disclosure of the interest (e.g., to an audience receiving the results of clinical research or at scientific or educational sessions).

Recusal from voting on a matter and limitation of the individual’s participation only to the provision of factual information of benefit to the group discussion.

Complete recusal from a portion of a meeting or from other consideration of the subject matter.

A decision not to invite someone to participate in an ASSH activity.

Replacement of the individual in the affected position or activity.

In most instances, disclosure of the conflicting or potentially conflicting interest will itself suffice to protect ASSH’s interests. In other words, once such a conflict is fully disclosed to the relevant parties, they generally will be able to evaluate the possible influence of the disclosed interest. However, in other situations, disclosure alone is not deemed to be sufficient. In situations where disclosure does not adequately deal with actual or potential problems, additional action, including denial of participation in the affected activity or consideration of the matter, may be appropriate or necessary. ASSH’s adherence to ACCME’s standards for Commercial Support provides examples where such denial is required.

It should be noted that Council has determined that certain relationships – dualities of interest, for example, where a member has potentially competing duties of loyalty – are so pervasive that such conflicts and dualities of interest should be avoided from the outset. In other words, denial of participation often is best implemented by not allowing the participation in the first instance. For example, many members serve on the Boards of organizations that have a commonality of interest with ASSH. That can be a very good thing. However, when a member serves on the Board of another organization and, simultaneously, serves in a position of leadership and influence in ASSH, the potential conflicts and dualities of interest often can be too fundamental to be managed by either disclosure or recusal, and too awkward and difficult to implement by after the fact denial of participation.

As such, Council is providing guidance that certain conflict situations should be avoided at the outset. Examples of such situations include persons serving on the boards of organizations such as AAHS, AAOS, ASPS, OREF, etc. who seek to serve in key leadership roles at ASSH (in the Presidential Line, for example, or as an officer or member of Council, or as a trustee of AFSH). These types of conflict scenarios should be avoided, upfront, to the degree possible or practical. Similarly, serving as an Editor of JHS and seeking to simultaneously serve in another ASSH leadership position also may be problematic and should be avoided. A table summarizing ASSH’s general guidance on organizational relationships is attached as Attachment B.

In all such situations, Council or their designee(s) will weigh all of the facts and circumstances and determine what is in the best interests of ASSH. For example, in weighing the facts and circumstances, Council or their designee(s) may determine that serving as, say, an ASPS director would not preclude someone from serving in the ASSH Presidential Line, but serving as an ASPS officer would. Similarly, Council or their designee(s) may weigh the facts and circumstances and determine that no one serving as an AAHS director should serve as a member of Council.

In all circumstances, members who seek to serve in leadership roles in ASSH are cautioned to avoid conflict and duality of interest situations which could result in an upfront denial of participation in an ASSH leadership role. Or, in the alternative, and in order to serve in a leadership role in ASSH, they should be prepared to sever the duality of interest position.

Council has charged the Executive Committee with having primary responsibility for interpreting and applying this Conflict of Interest Policy. As such, the Executive Committee will regularly review all conflict of interest disclosure forms and will be available to provide advice to ASSH committees, task forces, members, or staff on managing conflicts of interest including, without limitation, policies, practices, and procedures on disclosure, recusal, and/or denial of participation. In the special circumstance of the Nominating Committee, the Executive Committee shall not influence the recommendations coming from the Nominating Committee, but may review specific candidate recommendations and advise Council on potential conflict and duality of interest issues with respect to nominees.

CME Disclosure Requirements

ASSH is committed to fully complying with ACCME’s Standards for Commercial Support. As such, for CME related activities, in addition to complying with ASSH’s Conflict of Interest Policy, individuals also must comply with additional, special rules for identifying relevant financial relationships and resolving conflicts of interest. Those additional, special rules are set forth in ASSH’s CME Conflict of Interest Policy and Disclosure Form, which is attached and incorporated by reference.

Purpose
The purpose of this policy statement is to establish the obligations, and preserve the rights, of the Hand Society and its authors, presenters, and other contributors (collectively, “contributors”) with respect to intellectual property presented during Hand Society programs or other activities.

Background
The ASSH understands the considerable effort required to create quality education products. Due to advances in multimedia technology, it is inevitable that this material will be highly visible and, consequently, subject to greater public scrutiny and possible misuse. For this reason, among others, it is important for the Hand Society to establish a coherent statement of policy regarding its receipt and use of intellectual property. Accordingly, this policy statement establishes (i) the process by which the Hand Society will determine the material that will be required for a particular program or activity, how it will be used, and the respective rights of the Hand Society and contributors to that material; (ii) the terms on which the Hand Society will accept material for presentation or publication; and (iii) the steps that the Hand Society will take to preserve its rights in the property, as well as those of its contributors.

Scope of Rights
Prior to inviting contributors to participate in, or otherwise contribute to, an ASSH educational program or other activity, the Hand Society will determine (i) the format(s) in which the program or other activity will be presented, published, or republished (e.g., podium talk, program binder, journal, textbook, audiotape, videotape, CD-ROM, digital course); (ii) the written materials that will be required for the program or activity (e.g., slides, syllabus, manuscript, PowerPoint (or digital) presentation); and (iii) the respective rights (e.g., copyright ownership, exclusive license, right to first publication, right to reprint, acknowledgement) of the Hand Society and the contributor in the contributed material, as well as in any materials produced by the Hand Society in connection with the program or other activity.

In selecting the appropriate format for presentation of its intellectual property, as well as the intellectual property of its contributors, the Hand Society will take into consideration several factors, including the relative costs, availability, ease of use/convenience and, especially, security features of potential formats. Because of the heightened risk of piracy of digitally captured and commercially reproduced intellectual property, the Hand Society will exercise discretion in calling for any digital reproduction of materials, especially when contributors will retain rights. Under all circumstances, the Hand Society will undertake reasonable efforts to maintain the security of the subject materials.

In determining the respective rights of the Hand Society and its contributors in the materials, the Hand Society will take several matters into account, including the intended use of the materials, their anticipated visibility, restrictions imposed by third parties, whether the Hand Society has a need to maintain exclusive control, and contributors’ desire to preserve their own rights of ownership and/or publication. Where the contributed material will not be recorded, reprinted or otherwise reproduced the Hand Society ordinarily will seek appropriate rights to the material; in all other circumstances (e.g., podium presentation only), the Hand Society ordinarily will not seek such rights.

Copyright law provides a “bundle” of rights to the creator of an original work, including, for example, the exclusive right to reproduce the work, distribute the reproductions, display and perform the work, prepare derivative works based on the original, and authorize others to any of those things. Creators of copyrightable works can transfer copyright ownership (and the bundle of rights that go along with it) to others. With the exception of Journal articles, for example, the Hand Society ordinarily will not seek to own the copyright in works created by others.

Instead, the Hand Society will seek to obtain rights to use the copyrighted material through the use of a license. Copyright owners may grant licenses covering all or a portion of the bundle of rights described above, on an exclusive or non-exclusive basis. Where an exclusive license is granted, the licensee has the sole right to exercise that right (e.g., to reproduce the work). Where rights are granted on a non-exclusive basis, the copyright owner may authorize others to use the same material. Copyright licenses also can be granted for limited or unlimited time. Thus, depending on the circumstances, the Hand Society may seek a license for some or all of the rights included in the copyright, on an exclusive or non-exclusive basis, and for a limited time or for the life of the copyright. Any rights not specifically covered in the license are retained by the creator of the work.

In each instance, the Hand Society will determine the scope of rights in a work which it seeks and will notify potential contributors regarding the above determinations sufficiently in advance of the scheduled program or production to allow the affected parties time to assess their willingness and interest in participating and to allow alternate participants to be chosen, if necessary. All contributors must agree to abide by ASSH’s policies on intellectual property, including, but not limited to , the terms and conditions of presentation or publication. Contributors will not be allowed to “opt out” from meeting any or all of those requirements.

Requirements for Participation

Every contributor to a Hand Society educational program or activity is required to represent to the Hand Society that:

The content of his or her materials is accurate to the best of his or her knowledge;

The materials do not violate any copyright, proprietary rights or personal rights of others;

The materials, including photographs, do not identify any patient or others; or, if they do, the contributor has obtained all necessary consents for the further use of such materials;

The article, presentation or other materials will be educational in nature, will not promote any product of service, and will not contain any false or misleading statements regarding any products or services or include materials that are slanderous, libelous or otherwise illegal; and

The contributor is authorized to make those representations.

Because the Hand Society is not in a position to conduct an independent investigation into the accuracy or ownership of presentation materials, or whether those materials may violate the rights of third parties, contributors also must indemnify the ASSH against any liability arising from a breach of the foregoing representations. By requiring contributors to make the above representations, it is the Hand Society’s intent that contributors will determine whether those representations can be made and, as such, will take the steps necessary to protect themselves from possibly violating others’ rights.

Requests to Reproduce
Unless the copyright is transferred or an exclusive license is granted, individual authors do not need the Hand Society’s permission to reproduce their own materials. Any individual or organization desiring to reproduce intellectual property that the Hand Society owns or is licensed to reproduce must make an application in writing (or on the Web) to the ASSH Central Office. The Central Office is authorized to grant permission for use of this material, as long as the requesting party provides a written statement acknowledging and agreeing: (i) that its primary use will be for educational purposes; (ii) to abide by all ASSH intellectual property policies; and (ii) to prominently acknowledge the contributor as well as the ASSH’s rights to the material. If the Central Office has any questions regarding the appropriateness of the request, it shall refer the matter to Council.
Policy Implementation
The ASSH Central Office is responsible for the administration of this policy and, as such, shall create and distribute all materials, including, but not limited to, information to prospective contributors, consent forms, licenses, notices, and reprint permissions, in compliance with these policies and procedures.

The initial forms and directives resulting from this policy will be developed in consultation with the ASSH IP Task Force. Thereafter, the Central Office may develop additional forms and make administrative modifications; however, Council must approve any changes in intellectual property policy.

Introduction

To be in compliance with the ACCME Policy on Internet CME, the American Society for Surgery of the Hand (ASSH) requires that General CME Information must be transmitted to the learner prior to the educational activity. For electronic activities including Internet, DVD, satellite broadcasts, iPods, etc., the following are required:

ASSH may not place their CME activities on a website owned or controlled by a commercial interest (CI).

Web-based General CME Information must be transmitted to the learner prior to the educational activity. This means learners must read all required CME information prior to entering the CME activity.

Required CME Information includes:

Planner/faculty disclosure information

Accreditation Statement

AMA PRA statement

Learning Objectives

Release and expiration dates as well as review and re-release dates

Medium or media used

Requirements for participation

Hardware and software requirements

ASSH’s contact information

Privacy policy and confidentiality

Copyright that serves to document that ASSH owns the copyright for the CME materials provided in the CME activity or a statement of permission to use the copyrighted materials from another source

Links to Product Websites

ASSH may provide links to pharmaceutical or device manufacturer product websites if the link is provided in the manner described below:

There must be clear notification that the learner is leaving the educational website.

The link may be provided before or after the CME activity but cannot be embedded within the content of the CME activity.

Advertisements
No advertisements may occur within the CME content of an educational activity. This includes the following:

Banner ads

Subliminal ads

Pop-up window ads

For web-based activities, including enduring or live Internet activities, ads and promotional materials may not be visible on the screen at the same time as the content or CME information is provided. It cannot be interleafed between computer windows.

The American Society for Surgery of the Hand ("ASSH") provides the following guidelines to assure the proper and consistent use of its name and logo.

Referencing ASSH Membership

ASSH members may reference their ASSH membership on websites, business cards, letterhead, advertisements, and other methods of communication as follows, provided the written reference is set in a font equal to or smaller than that used for the member’s name. When a logo is used to reference membership, the font in the logo must be smaller than the font used for the member’s name.

Active Members, including Retired Members, may reference “Member, American Society for Surgery of the Hand”

Lifetime Members may reference “Lifetime Member, American Society for Surgery of the Hand” or “Member, American Society for Surgery of the Hand”

International Members may reference “International Member, American Society for Surgery of the Hand” or “Member, American Society for Surgery of the Hand”

Candidate Members may not advertise or represent themselves as a “Member of the American Society for Surgery of the Hand” but may state “Candidate Member, the American Society for Surgery of the Hand”

Affiliate Members may not advertise or represent themselves as a “Member of the American Society for Surgery of the Hand” but may state “Affiliate Member, the American Society for Surgery of the Hand”

Supporting Members may not advertise or represent themselves as a “Member of the American Society for Surgery of the Hand” but may state “Supporting Member, the American Society for Surgery of the Hand”

Honorary Members may not advertise or represent themselves as a “Member of the American Society for Surgery of the Hand” but may state “Honorary Member, the American Society for Surgery of the Hand”

All members may reference their membership, as well as any ASSH offices held, in biographical material (i.e. curriculum vitae, resume, publication jackets, etc.)

In a group practice setting, where fewer than all of the members of the group are Active, Lifetime or International members, the ASSH name may only be used in clear reference to the Active, Lifetime and International members, not to the other members of the group.

Use of ASSH Logo

Active (including Retired), Lifetime, and International Members in good standing of the American Society for Surgery of the Hand may use the ASSH logo to indicate their ASSH membership on their business cards, stationery, emails, websites, social networking sites, patient educational materials they have developed, and advertisements of their practice.

All other members of the American Society for Surgery of the Hand may not use the ASSH logo on their business cards, stationery, emails, websites, social networking sites and other methods of advertising.

ASSH will provide members with electronic artwork and guidelines for graphic use of the Logo.

The Logo is provided only as a graphical representation to promote the ASSH and/or to indicate that an individual is a member, and is not in any way an indication of ASSH sponsorship or endorsement of the content of the site it appears on.

The Logo is owned by ASSH and all uses of the Logo inure to the benefit of ASSH.

ASSH reserves the right to change or modify the Logo and/or these Guidelines at any time at its discretion. Permission to use the logo is limited to those who meet the then applicable criteria, and those who no longer meet the criteria must discontinue the use of the logo. Any use of the Logo that is not consistent with these guidelines is strictly prohibited.

Downloadable Logos

The American Society for Surgery of the Hand (“ASSH,” “we,” or “us”) has created and posted this privacy policy in an effort to maintain efficient service while respecting your privacy and protecting your personal information. This privacy policy is incorporated into and is a part of the Policies and Technical Requirements of our website. Specifically, this privacy policy covers the following topics:

Information Collection

Children’s Information

Information Use

Information Sharing

Access to and Control of Information

Data Security

Data Retention

Data Transfer

External Links

Privacy Policy Updates

Acceptance of Privacy Policy Terms

ASSH Contact Information

INFORMATION COLLECTION

This privacy policy applies to information that ASSH collects (i) on the ASSH website (Site), (ii) through other platforms used in connection with the services and products that we provide, and (iii) by telephone, email, text message, letter, or other methods of communication. When you use our services or products, we collect (i) information provided voluntarily and (ii) information collected automatically, as described in detail below.

Information Provided Voluntarily

Member and e-learner Contact Information: We will collect personally identifiable information that you provide to us, including, but not limited to, your name, employer's name, mailing address, telephone number, e-mail address, and medical specialty. Such information is necessary to facilitate your access to, use of, purchase of, or participation in our service and product offerings, including, but not limited to: membership; events, meetings, or conferences; educational programs; and online forums. Please note that you may decline to share your personal information with us, in which case we may not be able to provide you with certain aspects of our services or products.

Member Demographic Information: We will collect demographic information that you provide to us, including, but not limited to, your birthdate, gender, ethnicity, spouse name, photo. You will be asked to consent to the collection of such information in accordance with this privacy policy at the time of collection, and you may withdraw that consent at any time. Such information is collected to analyze member demographics and improve the member experience.

Enrollment, Registration, and Order Form Information: In order to enroll in or register for an ASSH program, attend ASSH events, meetings, or conferences, or request products or services, you will be required to fill out a registration or order form and provide personally identifiable information, which we will use to process your registration or order. In certain circumstances, a program, event, meeting, or conference accessed through the Site may be jointly sponsored or co-sponsored with another organization. If the enrollment or registration is handled by such other organization, that organization’s (not ASSH’s) privacy policy will apply and be controlling. Please note that ASSH is not responsible for the privacy policies of such other organizations or their collection, use, sharing, or other processing of your personal or other information, and ASSH hereby disclaims any liability or responsibility in connection therewith.

Cookies: Cookies are pieces of stored information on a user’s computer or device that are tied to information about the user and used to provide smoother navigation throughout the Site, such as to store a saved password; to identify user trends, such as page views; and for other internal purposes, such as to assess the effectiveness of the Site. You have the option of setting your computer to disable cookies or to alert you when cookies are being used. If you choose to disable cookies, please be aware that portions of the Site may not function properly.

Log Files: Log files store information such as a user’s IP address, browser type, Internet Service Provider (ISP), referring/exit pages, platform type, date/time stamp, and number of clicks. Like most websites, the Site uses log files to analyze trends, administer the Site, and track users’ movement on the Site.

CHILDREN’S INFORMATION

The Site and our services and products are not directed toward children under the age of 16. We do not knowingly collect information from children. If we become aware that a child has provided us with information without parental consent, that information will be deleted from our records.

INFORMATION USE

ASSH uses the information that we collect to provide our services and products and to operate our business. We may use and store such information for legitimate and lawful business purposes, for example, in order to:

provide a service or product you requested;

secure your membership status;

fulfill your membership benefits;

analyze and evaluate member and prospective member needs and interests, and improve the member and prospective member experience;

For individuals located in the European Economic Area, we rely on multiple legal bases to collect, use, share, or otherwise process your personal data, including that:

you have given consent, which you may withdraw at any time;

it is necessary for us to perform a contract with you;

it is necessary for us to comply with legal obligations;

it is necessary for our or a third party’s legitimate interests;

it is necessary for us to perform a task in the public interest or for our official functions; and/or

it is necessary to protect someone’s life.

To the extent we rely on our legitimate interests as a legal basis to collect, use, share, or otherwise process your personal data, those interests include: providing a product or service you requested; securing your membership status; fulfilling your membership benefits; analyzing and evaluating member and prospective member needs and interests, and improving the member and prospective member experience; notifying you of ASSH official business, news, activities, programs, events, meetings, conferences, services, products, and benefits; tracking event, meeting, and conference attendance; tracking education related activities; tracking CME credits earned; preparing invoices and process payments; responding to communications and inquiries that you send to us; and promoting the function, safety, and security of our services.

INFORMATION SHARING

Personal information may be given to a third party in order to complete a specific business transaction on behalf of ASSH. Such transactions may include the following:

Your member contact information, as provided to ASSH, may be shared with ASSH members to provide a service, satisfy a question, or develop a prospective business relationship.

Your member contact information, as provided to ASSH, may appear on registration or attendee lists distributed at ASSH programs, events, meetings, and conferences to other attendees, including members, and other third parties, including, but not limited to, exhibitors or sponsors.

We also may disclose personal information if we become subject to a subpoena, court order, or law enforcement or other government agency inquiry or investigation or if we are otherwise legally required to disclose such information. We also may use and disclose information about you to establish or exercise our legal rights, to enforce the Terms and Conditions of Use Agreement, to assert and defend against legal claims, or if we believe such disclosure is necessary to investigate, prevent, or take other action regarding actual or suspected illegal or fraudulent activities or potential threats to the physical safety or well-being of any person.

If all or part of ASSH is merged into or otherwise transferred to another entity, we may transfer the personal information you provided to us to such entity as part of that transaction.

ACCESS TO AND CONTROL OF INFORMATION

ASSH takes your privacy and the protection of your personal information seriously, and we will provide you with reasonable access to and control of the personal information that you have provided to us. You may request to update your personal information or to opt in to or opt out of any service offerings at any time.

For individuals located in the European Economic Area, you may have additional rights concerning your personal data, such as to access, obtain a copy of, correct, or delete that information or to withdraw your consent or object to the collection, use, sharing, or other processing of that information. To make any request with respect to your personal information, please contact ASSH as set forth below in the “ASSH Contact Information” section.

DATA SECURITY

We employ reasonable physical, electronic, and procedural security measures to safeguard your personal information and to help protect against unauthorized access and disclosure. Online registration information, such as payment card information, will be secured using a commercially accepted method of encryption. However, please be aware that no method of electronic transmission is completely infallible, and we cannot guarantee its absolute safety. We encourage you to use reasonable care in how you handle and disclose your personal information, user name(s), and password(s). If you become aware of any breach of Site security, please contact us immediately.

DATA RETENTION

ASSH retains your personal information for as long as necessary to fulfill the purposes for which it was collected as set forth in this privacy policy, after which we will securely destroy or delete such personal information from our records unless otherwise required by law. We will retain and use information as necessary to comply with legal obligations, resolve disputes, enforce agreements, and as otherwise set forth in this privacy policy.

DATA TRANSFER

If you are visiting the Site from outside the United States, please be aware that you are sending information, including personal data, to the United States where our servers are located. That information may then be transferred within the United States or to other countries outside the United States other than your country of residence. Countries other than your country of residence, including the United States, may have data privacy and protection laws that differ from, and potentially provide less protection than, the applicable laws in your country of residence.

To the extent that ASSH may be deemed to have transferred personal data outside of the European Economic Area, we rely on multiple legal bases for doing so. For individuals located in the European Economic Area, by providing your personal information, you consent to our use of it in accordance with this privacy policy, including the transfer of your information across international boundaries to jurisdictions anywhere in the world as permitted by applicable law. In addition, when transferring the personal data of individuals located in the European Economic Area, we will use the standard contractual data protection clauses adopted by the European Commission, which provide safeguards for the transfer of such data, in connection with the provision of certain services that involve such transfers. Finally, we may obtain separate consent from individuals located in the European Economic Area in connection with the provision of certain services that involve the transfer of personal data.

Our collection, use, sharing, and other processing of your personal information will at all times be governed by this privacy policy.

EXTERNAL LINKS

There are external links to other websites throughout the Site and within ASSH’s online CME course materials. Please note that ASSH is not responsible for the privacy policies of those other websites and hereby disclaims any liability or responsibility in connection with such linked websites.

PRIVACY POLICY UPDATES

Should any changes be made to this privacy policy, we will post them on this page with appropriate explanation.

ACCEPTANCE OF PRIVACY POLICY TERMS

Using the ASSH Site indicates your acceptance of our privacy policy. Your continued visits to the ASSH Site after changes are posted to this policy will signify your acceptance of those changes.

ASSH CONTACT INFORMATION

If you have any questions or concerns about this Privacy Policy and/or how we process personal data, or would like to exercise any of the legal rights set forth above, please contact us at:

The American Society for Surgery of the Hand enthusiastically supports and explores the use of social media tools and emerging technologies, and we encourage ASSH members and staff to do the same. Those who do should adhere to the following guidelines.

Why We Participate
Our interest in participating in social media is to meet our members (and future members) wherever they are, and to develop and enhance relationships with members and other stakeholders involved in the field of upper extremity care. Social media use is increasingly important given the rapid evolution of these tools, so we strive to stay current on emerging technologies to remain relevant to our respective audiences.

While the decision whether to participate is your own, ASSH members and staff are encouraged to explore all forms of social media and find the one(s) that best fit their needs. This expands our ability to learn and share our own knowledge with others.

Guidelines to Follow
Here are a few generally accepted guidelines to consider when using social media:

First and foremost, remember you are representing ASSH and the field of upper extremity surgery. Your conduct should be consistent with our mission, vision and values.

You are personally responsible for the content you post. Remember that what you post can often be viewed by both personal and professional contacts, so post responsibly, and protect your privacy.

If you publish content related to ASSH on any non-ASSH site, identify yourself and use a disclaimer such as, "The views in this post are my own and not necessarily those of ASSH."

Do not publish any confidential or proprietary information on a social site.

Do not discuss other ASSH members, patients or industry partners without their approval.

Link back to the original source whenever possible.

Be yourself. Do not post anonymously or use pseudonyms.

Be aware of and respect copyright, fair use and financial disclosure laws.

Contribute to the knowledge pool. Whenever possible, post content that adds value to your social friends and followers.

Use your best judgment. If you aren't sure whether what you are about to post is appropriate, review it carefully and question what you've written with an objective mind. If you are still unsure, ask an ASSH staff member for his or her opinion. Remember, though, that you are solely responsible for what you post in any social media format.

Own up to your mistakes. If you have made an error, say so -- but do not alter the original text of the incorrect post. Instead, add an update in which you explain and correct the error.

Remember who you work for. Don't let social media activities interfere with your duties and your commitment to members, patients or colleagues.

ASSH encourages comments and discussion on our various pages and message boards. We do not pre-moderate any comments and welcome all kinds of thoughts - supportive, dissenting, critical or otherwise. We do not delete or censor comments unless they have content that:

Is abusive.

Is disruptive or off-topic.

Contains ad-hominem attacks.

Promotes hate of any kind.

Uses excessively foul language.

Is blatantly spam.

Is reported as abuse.

Please remember that when you post a comment, it is published for all to see. The views and opinions expressed in the comments are strictly those of the author(s) and in no way represent those of ASSH. We assume no liability for the information therein and extend no implied or expressed warranty or guarantee of accuracy.

We can't respond to every comment, particularly those that deal with individual medical cases and issues.

Remember
Explore and have fun. Experiment with tools, both in and out of the ASSH domain, and think about how they might be used to benefit ASSH and its members. Share resources, insights, opinions and advice with your followers and ask the same of them.

Notice

This Web site is provided as a service of the American Society for Surgery of the Hand (ASSH). The entire contents and design of the ASSH Web site, including all trademarks, logos, trade names, documents, databases, graphic representations, and other information, are the property of ASSH, or used by ASSH with permission, and are protected under U.S. and international copyright and trademark laws, whether or not a notice of copyright, trademark, or other proprietary rights appears on the screen displaying the information. Except as otherwise provided herein, users of the ASSH Web site may save and use information contained on the site only for personal or other non-commercial, educational purposes. No other use, including, without limitation, reproduction, retransmission or editing, of ASSH Web site information may be made without the prior written permission of ASSH, which may be requested by contacting the ASSH Central Office.

Disclaimer

ASSH makes no warranty, guarantee, or representation as to the accuracy or sufficiency of the information posted on the ASSH Web site. The information, opinions, and recommendations presented within ASSH’s Web site are for general information only. Such information should not be considered medical advice and is not intended to replace consultation with a qualified hand surgeon. Unless specifically stated otherwise, ASSH does not endorse, approve, recommend, or certify any information, product, process, service, or organization presented or mentioned on the ASSH Web site, and information from the Web site should not be referenced in any way to imply such approval or endorsement. Moreover, ASSH makes no warranty that its Web site, or the server that makes it available, is free of viruses, worms, or other elements or codes that manifest contaminating or destructive properties. ASSH EXPRESSLY DISCLAIMS ANY AND ALL LIABILITY OR RESPONSIBILITY FOR ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL OR OTHER DAMAGES ARISING OUT OF ANY INDIVIDUAL’S USE OF, REFERENCE TO, RELIANCE ON, OR INABILITY TO USE, THE ASSH WEB SITE OR THE INFORMATION PRESENTED ON THE SITE.
Links or pointers connecting the ASSH Web site with other Internet sites are provided as a courtesy only and do not imply, directly or indirectly, the endorsement, sponsorship, or approval by ASSH of the linked site, the organization or individual operating the site, or any product, service or organization referenced in the site. In general, any Web site that has an address (or URL) that does not contain “assh.org” or “handcare.org” is a linked Web site. The content of any linked site does not necessarily reflect the opinions, standards or policies of ASSH. ASSH assumes no responsibility or liability for the accuracy or completeness of content contained in any linked site or for the compliance with applicable laws of such linked sites.

Tip 4: Your results can be refined by using either the tabs at the top (Video, Articles/WEB, Images, JHS, Products/Vendors), or the filters on the left (Filter by Source, Filter by Format, Filter by Purpose, etc.).

Tip 5: Punctuation can enhance your search as well. Use quotes ("search term") to only include
pages with the same words in the same order. But only use this if you are looking for an exact word or phrase, otherwise you may exclude helpful results. Add an asterisk (search term*) as a placeholder for any unknown or wildcard terms. For example, C*l Tunnel would give you results for Cubital Tunnel and Carpal Tunnel. Place a question mark (search term?) for single-character wildcard matching. For example, pa?ent would give you results for parent, patent, etc. You may also use the plus sign (search + word) between words for words you must have in the results.

Tip 6: We are always trying to improve our search, if you are having any trouble with search please refer to our survey here and we will use your comments to improve our search. You can also watch our search help video.